An­na-Lisa Paul

Ju­ve­nile di­a­betes is not a death sen­tence.

And al­though it took more than 15 years for Dr Anu­rad­ha Ja­goo-Gan­gaper­sad to un­der­stand this, the pae­di­a­tri­cian, now 36, is ful­fill­ing a per­son­al call to ed­u­cate peo­ple about the con­di­tion.

Di­ag­nosed at the ten­der age of three af­ter she col­lapsed dur­ing a fam­i­ly out­ing to the beach, Ja­goo-Gan­gaper­sad nev­er ful­ly un­der­stood why God had caused her to be af­flict­ed with the con­di­tion.

Re­fus­ing to de­scribe di­a­betes as a dis­ease, the bub­bly woman's ad­vice for chil­dren and par­ents of chil­dren di­ag­nosed with it is: "You can live a nor­mal life…you just need to un­der­stand it and how to deal with it."

The Ch­agua­nas res­i­dent, who has been op­er­at­ing out of the San Fer­nan­do Gen­er­al Hos­pi­tal for the last 12 years, said ju­ve­nile di­a­betes in T&T has been slow­ly in­creas­ing over the last ten years. She said they have been di­ag­nos­ing be­tween 50 to 60 cas­es of ju­ve­nile di­a­betes—Type 1 and Type 2—per year at that hos­pi­tal.

This fig­ure was in stark con­trast to the ones quot­ed by pae­di­a­tri­cian Dr Viren­dra Singh, Er­ic Williams Med­ical Sci­ences Com­plex, Mt Hope, who re­vealed that al­though there has been an in­crease in di­a­betes cas­es at that in­sti­tu­tion, be­tween 30 and 36 year­ly, 18 to 20 of those cas­es are ju­ve­nile di­a­bet­ics.

He said, "We are see­ing an in­creased rate of ju­ve­nile di­a­betes."

This was sup­port­ed by Pub­lic Re­la­tions Of­fi­cer of the Di­a­betes As­so­ci­a­tion of T&T Zo­bi­da Rag­birs­ingh who agreed ju­ve­nile di­a­betes is on the rise.

How­ev­er, the three of­fi­cials agreed true sta­tis­tics were hard to come by as there were peo­ple ac­cess­ing pri­vate health care who would not form part of the pub­lic health records. There are al­so no prop­er records at the pub­lic health fa­cil­i­ties.

'It was ex­treme­ly trau­ma­tis­ing for me as a child'

Re­count­ing the cir­cum­stances which led to her ini­tial­ly be­ing di­ag­nosed, Ja­goo-Gan­gaper­sad said, “Since I was about two-and-a-half and my par­ents were pot­ty train­ing me, they al­ways no­ticed ants sur­round­ing the rim of the pot­ty.

"They no­ticed the urine was al­ways heavy and had an un­usu­al smell. They al­so no­ticed I was los­ing a lot of weight and they thought some­thing was se­ri­ous­ly wrong but as a child who was al­ways hy­per­ac­tive, they didn’t want me to go through a bat­tery of tests un­nec­es­sar­i­ly."

Fol­low­ing her col­lapse soon af­ter she turned three, Ja­goo-Per­sad’s par­ents were shocked to learn that her glu­cose lev­el was over 600.

Ward­ed for one month at the San Fer­nan­do Gen­er­al Hos­pi­tal while nu­mer­ous tests were car­ried out, her par­ents be­came frus­trat­ed with the slow pace at which an­swers were be­ing giv­en to them and they opt­ed to take her to a pri­vate doc­tor.

Ja­goo-Gan­gaper­sad said her par­ents be­gan read­ing every sin­gle piece of lit­er­a­ture they could find so they could learn more about Type 1 di­a­betes which is what she was even­tu­al­ly di­ag­nosed with.

Ja­goo-Gan­gaper­sad said, "Back then, Type 1 di­a­betes was kind of un­heard of in Trinidad and it was very dif­fi­cult to di­ag­nose es­pe­cial­ly at that young age."

To date, she re­mains un­cer­tain what ex­act­ly trig­gered the con­di­tion.

She ex­plained, "They sus­pect­ed I may have got­ten some kind of virus and some kind of ge­net­ic spon­ta­neous mu­ta­tion that oc­curred in my fam­i­ly his­to­ry and I just pre­sent­ed at that time with it."

Read­i­ly ac­knowl­edg­ing her fam­i­ly’s long his­to­ry with di­a­betes, she re­ferred to it as "a rare, one-off sort of thing".

In­di­cat­ing there were hard­ly any ma­chines to test for di­a­betes as is the case now, she said, "We had to do urine test­ing on a Bun­sen burn­er."

"I re­mem­ber my par­ents buy­ing Bene­dict So­lu­tion and they had what you see in a lab lit­er­al­ly, a test tube and Bun­sen burn­er with a han­dle. They would fill a cer­tain amount of liq­uid in there, put some urine and test it, and de­pend­ing on the colour change, they would know if my sug­ar lev­el was high or low."

She re­mem­bered the dif­fi­cul­ty her par­ents en­coun­tered to ob­tain in­sulin which was very ex­pen­sive and on­ly ac­ces­si­ble by the favoured few.

Dur­ing her hos­pi­tal­i­sa­tion she re­mem­bered cry­ing and ex­pe­ri­enc­ing aban­don­ment is­sues as she saw oth­er chil­dren be­ing dis­charged while she re­mained con­fined to a bed, won­der­ing when she would be able to re­turn home.

"My par­ents tried to con­sole me but I al­ways thought that they hat­ed me be­cause as a lit­tle child, I thought they were an­gry with me be­cause of some­thing I did, every day they would come and see me but leave me and come back.

"I al­ways thought I was a bad child and that some­thing was wrong, and that is why they were treat­ing me that way and the doc­tors were stick­ing me every day with nee­dles and that sort of thing."

Ja­goo-Gan­gaper­sad al­so re­called hav­ing to stick to dras­ti­cal­ly mod­i­fied meals which saw her con­sum­ing a bland di­et con­sist­ing of whole-wheat bread, sug­ar-free juices, skimmed milk, and re­duced-fat but­ter.

She laughed as she re­mem­bered hid­ing un­der a ta­ble and switch­ing food with some of the kids.

Ja­goo-Gan­gaper­sad al­so be­gan falling sick fre­quent­ly as the in­sulin back then was from an­i­mal stock to which she was al­ler­gic.

She said, "I be­gan cold sweat­ing, would get bad headaches and faint away. My sug­ar would go so low and some­times I would just sit in a cor­ner and knock out be­cause there was no glu­cose me­tre to check."

Tired and list­less most time, Ja­goo-Gan­gaper­sad said, "It was ex­treme­ly trau­ma­tis­ing."

De­spite the chal­lenges she faced, Ja­goo-Gan­gaper­sad said her fam­i­ly in­sist­ed on a sound ed­u­ca­tion­al foun­da­tion.

While she had been un­de­cid­ed about her ca­reer path up to mid­way dur­ing sec­ondary school, the urg­ings of a teacher to get a rich hus­band to take care of her made Ja­goo-Ganger­per­sad made her de­ter­mined nev­er to have to de­pend on some­one to pro­vide for her.

Grad­u­at­ing from Na­pari­ma Girls' Col­lege with nine dis­tinc­tions and four A’s, she pur­sued med­ical train­ing at the UWI Mt Hope Cam­pus be­fore com­plet­ing spe­cial­ist train­ing at the Roy­al Col­lege of Physi­cians & Child Health in Eng­land.

Up­on her re­turn to T&T, Ja­goo-Gan­gaper­sad opt­ed to prac­tice at the place where she was first hos­pi­talised—the San Fer­nan­do Gen­er­al Hos­pi­tal.

As an adult, she now has to take in­sulin up to four times dai­ly, but this has not slowed her down in any way.

Liv­ing with di­a­betes for six years...Girl, 10, ques­tions her­self

Speak­ing about the chal­lenges she has faced as the moth­er of ten-year-old Jan­vie Ramkissoon who has been liv­ing with Type 1 di­a­betes for the past six years, Natasha said her off-spring was a nor­mal ac­tive tod­dler who seemed not to be re­cov­er­ing fast enough from a "reg­u­lar flu" at the age of four.

Un­aware of di­a­betes and its ef­fects as no one in her fam­i­ly had ever been di­ag­nosed with it be­fore, Natasha said Jan­vie’s glu­cose lev­el was climb­ing to 700 and above af­ter her doc­tor re­ferred her for a blood test.

Still un­sure of what they were deal­ing with, Natasha teared up as she said, "I had to learn to ad­min­is­ter the in­sulin to her as a child. Imag­ine hold­ing a nee­dle and my hand was shak­ing so bad. It was hard."

How­ev­er, she said Jan­vie was a brave and in­tel­li­gent child who quick­ly un­der­stood she was dif­fer­ent from her peers.

Chang­ing her daugh­ter’s di­et and en­sur­ing she be­came more ac­tive, Natasha said mod­er­ate por­tion sizes have since be­come a part of her nor­mal life.

Natasha said while Jan­vie still con­tin­ues to ques­tion her­self, her fa­ther has opt­ed to coun­sel her by re­in­forc­ing,'' You are a very spe­cial child, God chose you be­cause he knew you could han­dle it'."

The Stan­dard Four pupil is re­quired to take in­sulin twice dai­ly but con­tin­ues to fol­low a nor­mal rou­tine which now in­cludes ad­min­is­ter­ing her own in­sulin in­jec­tions.

About di­a­betes

•There are two main types of di­a­betes: type 1 and type 2.

•Both types of di­a­betes are chron­ic dis­eases that af­fect the way your body reg­u­lates blood sug­ar or glu­cose.

•Peo­ple with type 1 di­a­betes don't pro­duce in­sulin.

•In­sulin is a type of hor­mone pro­duced by the pan­creas to reg­u­late how blood sug­ar be­comes en­er­gy.

•An im­bal­ance of in­sulin or re­sis­tance to in­sulin caus­es di­a­betes.